Do Rewards Work as a Treatment For Alcoholism Among the Mentally Ill?

By Paul Gaita 02/15/17

Treating the dual-diagnosis of addiction and mental illness has been a long-standing issue for the health care industry.

Woman making a choice.

Researchers have determined that a reward system of simple prizes and sundries may be an effective and low-cost method of helping individuals with mental illness overcome alcohol and even tobacco addiction.

In a study published in the January 2017 edition of the American Journal of Psychiatry, scientists from Washington State University (WSU) looked at whether the contingency management strategy—which uses incentives or rewards to encourage abstinence or completion of treatment for drug abuse—might prove useful in treating alcohol addiction.

Prior to this study, the method had not yielded definitive results in that field of study, but the findings from WSU indicate that contingency management can produce positive results with individuals suffering from alcoholism, and in particular, individuals who have also been diagnosed with mental conditions such as schizophrenia or biopolar disorder.

The study authors followed a group of 79 outpatients in a mental health center in Seattle. The group was then divided into two control groups, the first of which was awarded small prizes ranging from necessities like soap and clothing to gift cards and media players for attending 12 weeks of addiction treatment and producing negative urine tests for alcohol use. The second control group received the same rewards at the 12-week mark regardless of treatment attendance and test results. 

After compiling data, the researchers found that the patients in the first group were three times less likely to test positive for alcohol use than those in the second group. The former group also continued to test in a similar manner throughout a three-month follow-up period.

Additionally, these patients were also five times less likely to test positive for tobacco use, and three times less likely to test positive for cocaine, than those in the second group.

The study findings may provide a simple and cost-effective solution for a longstanding problem in treating mentally ill patients with alcohol use disorder.

According to study lead investigator Michael McDonell, an associate professor at WSU's Elson S. Floyd College of Medicine, about 12% of individuals in that demographic receive simultaneous treatment for both conditions. Most receive treatment for either one condition or the other, which can complicate the level of care needed for successful treatment; these individuals are more likely to drop out of treatment and become homeless, which leads to poor physical health and expensive hospitalizations. The lifespan for patients with both conditions is estimated to be 20 to 25 years shorter than that of the average person. 

But as McDonell noted, "Using contingency management, we can treat their addiction at the same time as their mental illness, which can impact not only their alcohol and drug use, but also reduce smoking and improve health." Contingency management also requires less funding for training or supplies, which makes it ideal for areas that lack significant alcohol addition treatment facilities, such as rural locations or other low-income communities.

"This can be done anywhere and by just about anymore," McDonell said. "All you need to know is how to perform urine testing – which can be done with a simple dipstick – and give out prizes." McDonell and his fellow researchers have proposed additional studies that will examine if the treatment can prove effective for those with severe alcohol addiction, as well as with Native American and Alaska native groups.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.